This monograph describes a medication approved for use in Canada by the Therapeutic Products Directorate, a division of Health Canada’s Health Products and Food Branch. The medication is not approved by the United States Food and Drug Administration; however, a similar formulation carrying a different generic or brand name might be available in the US.
Treatment of chronic idiopathic constipation in adult females who do not respond to laxatives.
Acts as a serotonin (5–HT4) receptor agonist with prokinetic properties. Enhances peristalsis and gastrointestinal propulsion.
Absorption: Rapidly absorbed (90%) following oral administration.
Distribution: Rapidly and extensively distributed, enters breast milk.
Metabolism and Excretion: 60% excreted unchanged in urine, 3–8% unchanged in feces, minor amounts are extensively metabolized.
Half-life: 24 hr.
TIME/ACTION PROFILE (normalization of bowel movements)
|PO||3–4 days||1–4 wk||unknown|
- Renal impairment requiring dialysis;
- Intestinal obstruction/perforation (structural or function), obstructive ileus, severe gastrointestinal inflammatory disease, including Crohn's disease, ulcerative colitis, toxic megacolon/megarectum;
- Galactose intolerance, Lapp lactase deficiency or glucose/galactose malabsorption (tablets contain lactose);
- OB: Not recommended for use during pregnancy;
- Lactation: Not recommended for use while breast feeding;
- Pedi: Safety and effectiveness not established; not recommended for use.
Use Cautiously in:
- Severe/clinically stable concurrent chronic diseases including liver, cardiovascular or lung disease, neurological or psychiatric disorders, cancer, AIDS or other disorders or insulin-dependent diabetes mellitus;
- History of arrhythmias or cardiovascular disease, ischemic heart disease, pre-excitation syndromes (including Wolff-Parkinson-White syndrome, Lown-Ganong-Levine syndrome or AV nodal disorders (↑ risk of arrhythmias);
- Severe renal impairment (↓ dose recommended);
- Geri: Due to age-related ↓ in renal function, ↓ dose is recommended.
Adverse Reactions/Side Effects
CNS: headache, dizziness, fatigue
CV: palpitations, ↓ PR interval, tachycardia
GI: abdominal pain, diarrhea, nausea, vomiting
* CAPITALS indicate life-threatening.
Underline indicate most frequent.
- Severe diarrhea may ↓ effectiveness of oral hormonal contraceptives; additional method of contraception recommended.
- Blood levels and effects are ↑ by concurrent CYP3A4 and P-gp inhibitors including ketoconazole, verapamil, cyclosporine and quinidine.
- Beneficial effects may be ↓ by concurrent use of anticholinergics.
PO: (Adults) 2 mg once daily. If no bowel movement occurs in 3–4 days, add-on laxatives should be considered. If benefit is not obtained after 4 wk, prucalopride should be discontinued.
PO: (Adults) >65 yr): 1 mg once daily.
PO: (Adults) GFR <30 mL/min/1.73m2–1 mg once daily.
Tablets (contain lactose): 1 mg, 2 mg
- Assess for symptoms of chronic constipation (abdominal pain or discomfort, bloating, constipation).
- PO: Medication should be taken with food or on an empty stomach at the same time each day.
- Instruct patient to take prucalopride as directed.
- Caution the patient to discontinue the medication and notify health care professional with occurrence of severe diarrhea, signs of heart attack, black tarry stools, vomiting of blood or material that looks like coffee grounds.
- Advise patient on a nutritional regimen and hydration, and exercise to decrease constipation.
- Inform patient that if no bowel movement within 3 days of treatment, a "rescue" laxative may be added occasionally while taking prucalopride.
- Advise women of childbearing age who are taking prucalopride to use an effective method of birth control during treatment. If pregnant occurs while taking this medication, contact health care professional immediately.
A soft formed bowel movement.
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